摘要
目的了解补充不同剂量维生素D对极低出生体重儿血清钙、磷、碱性磷酸酶及25一羟维生素D水平的影响，为极低出生体重儿代谢性骨病的早期预防提供指导。方法选择2014年1月至2016年1月人住浙江省湖州市妇幼保健院新生儿科的90例极低出生体重儿为研究对象，随机分为高剂量组和低剂量组，于8日龄开始高剂量组予维生素D900U／d口服，低剂量组予400U／d口服。分别于1、7、21、42日龄检测血清钙、磷、碱性磷酸酶水平，7、2l、42日龄检测血清25一羟维生素D水平。采用两独立样本t检验、z。检验、单因素方差分析及LSD或Dunnett’sT3检验进行统计学分析。结果高剂量组和低剂量组1、7日龄的血清钙、磷和碱性磷酸酶，以及7日龄时的25一羟维生素D水平差异无统计学意义（P值均〉0．05）。21日龄时，高剂量组血清钙、磷和25一羟维生素D水平均较低剂量组高『分别为（2．38±0．09）与（2．04±0．15）mmol／L，t=2．421；（1．80±0．50）与（1．71±O．60）mmol／L，t=0．637；（45．58±18．43）与（42．53±16．33）nmol／L，t=0．421]，碱性磷酸酶较低剂量组低[（505．12±185．61）与（588．32±168．72）U／L，t=5．314]；差异均有统计学意义（P值均〈O．05）。42日龄时结果与21日龄时一致。高剂量组7、21和42日龄血清钙水平高于1日龄[分别为（2．43±0．13）、（2．38±0．09）、（2．39±0．08）与（2．06±O．57）mmol／L]；血清磷水平在7日龄时低于1、21和42日龄『分别为（1_31±0．26）与（1．89±0．39）、（1．80±0．50）、（1．984-O．30）mmol／L]；血清碱性磷酸酶在7、21和42日龄高于1日龄[分别为（475．184-133．73）、（505．12±l85．61）、（538．43±168．16）与（296．15±99．41）U／L]，42日龄高于7日龄；血清25一羟维生素D水平在21日龄明显高于7日龄，42日龄明显高于7和21日龄[分别为（73．55±23．65）与（30．63±12．66）和（45．58±18．43）nmol／L1；差异均有统计学意义（LSD或Dunnett’s T3检验，P值均〈0．05）。结论极低出生体重儿8日龄开始补充维生素D能改善钙磷代谢状态，900U／d效果好于400U／d。
Objectives To understand the effects of different doses of vitamin D supplementation on serum calcium, phosphorus, alkaline phosphatase and 25-hydroxyvitamin D levels in very low birth weight infants （VLBWI） and to provide guidance for early prevention of metabolic bone disease in VLBWI. Methods A total of 90 VLBWI hospitalized in the Department of Neonatology, Huzhou Maternal and Child Healthcare Hospital between January 2014 and January 2016 were enrolled and randomly divided into two groups： high dose group and low-dose group. High-dose group was given vitamin D 900 U/d orally and low-dose group was given 400 U/d since the eighth day after birth. Serum calcium, phosphorus and alkaline phosphatase levels were detected at 1, 7, 21 and 42 days of age and serum 25-hydroxyvitamin D levels were detected at 7, 21 and 42 days of age. Two-sample t-test, Chi-square test, one-way analysis of variance and LSD or Dunnett＇s T3 test were used for statistical analysis. Results No significant differences in serum calcium, phosphorus and alkaline phosphatase levels were found between the two groups at 1 and 7 days of age, nor were found in serum 25-hydroxyvitamin D level at 7 days of age （all P〉0.05）. At 21 days of age, high-dose group had higher serum calcium, phosphorus and 25-hydroxyvitamin D levels than low-dose group [（2.38±0.09） vs （2.0±0.15） mmol/L, t=2.421; （1.80±0.50） vs （1.71 ±0.60） mmol/L, t=0.637; （45.58± 18.43） vs （42.53±16.33） nmol/L, t=0.421], but lower alkaline phosphatase level [（505.12± 185.61） vs （588.32± 168.72） U/L, t=5.314] （all P〈0.05）. The same trends were found at 42 days of age. In high-dose group, serum calcium level increased at 7, 21 and 42 days of age as compared with that at 1 day of age [（2.43±0.13）, （2.38 ±0.09）, （2.39 ±0.08） vs （2.06 ± 0.57） mmol/L]; serum phosphorus level at 7 days of age was lower than that at 1, 21 and 42 days of age [（1.31 ±0.26） vs （1.89±0.39）, （1.80±0.50）, （1.98±0.30） mmol/L]; serum alkaline phosphatase level at 7, 21 and 42 days of age was higher than that at 1 day of age [（475.18± 133.73）, （505.12± 185.61）, （538.43± 168.16） vs （296.15±99.41） U/L] and a significant increase was observed at 42 days of age as compared with that at 7 days of age; serum 25-hydroxyvitamin D level at 21 days of age was higher than that at 7 days of age, and that at 42 days of age was higher than that at 7 and 21 days of age [（73.55 ± 23.65） vs （30.63 ±12.66） and （45.58 ± 18.43） nmol/L]; the differences were all statistically significant （LSD or Dunnett＇s T3 test, all P〈0.05）. Conclusions Vitamin D supplementation from the eighth day after birth can improve calcium and phosphorus metabolism in VLBWI and the dose of 900 U/d is more effective than 400 U/d.
作者
邓庆先
林梅芳
袁新华
富琴琴
蒋琦
王玉芳
文革生
Deng Qingxian Lin Meifang Yuan Xinhua Fu Qinqin Jiang Qi Wang Yufang Wen Gesheng.(Department of Neonatology, Huzhou Maternity and Child Care Hospital of Zhejiang Province, Huzhou 313000, China)
出处
《中华围产医学杂志》
CAS
CSCD
2017年第3期223-227,共5页
Chinese Journal of Perinatal Medicine
关键词
婴儿
极低出生体重
维生素D
钙
磷
碱性磷酸酶
生物学标记
Infant, very low birth weight
Vitamin D
Calcium
Phosphorus
Alkaline phosphatase
Biological markers
